Two of the largest low-wage healthcare sectors, home health and nursing home care, are increasingly dominated by private businesses, including private equity firms, which reduce care quality while increasing costs in pursuit of profits. Meanwhile, hospitals and clinics are increasingly contracting out healthcare services—replacing stable employment with the healthcare equivalent of gig work. Even the long overdue community health investments made during the pandemic tend to land in the hands of outside professionals rather than community members. Reversing these negative trends requires a different approach.
Worker ownership of healthcare services represents one promising alternative. In a worker-owned cooperative model, the healthcare business is owned and democratically governed by its workers through a one-worker, one-vote model. This model centers frontline workers rather than outside investors and has important benefits in addressing health, economic, and racial inequities.
Ownership by outside investors incentivizes short-term profits, even when that means high employee turnover and deteriorating quality of care. Alternatively, worker ownership incentivizes long-term investment in workers and care quality, resulting in higher wages, better employee benefits, and expanded training opportunities.
One crucial healthcare consequence of these investments is a dramatic reduction in turnover. Home care cooperatives had a 36 percent turnover rate compared to an industry average of 64 percent. Lower turnover is associated with higher quality care.